Left ventricle thrombus after tranexamic acid for spine surgery in an HIV-positive patient

Gerstein, Neal S.; Brierley, Janet K.; Culling, Matthew

doi:10.1016/j.spinee.2015.10.039

Cited by 9 publications

(4 citation statements)

References 44 publications

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“…(8,15,16) Although these studies indicate benefits, the systemic side effects in the form of thrombosis have not been investigated. Intravenous tranexamic acid administration is reported to be associated with thrombotic complications, (17)(18)(19) hence its use in the nebulized form should be with caution until definitively excluded with rigorous investigation.…”

Section: Discussionmentioning

confidence: 99%

Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism

Dhanani

Roberts

Reade

2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Hemoptysis and pulmonary embolism (PE) are life-threatening pulmonary emergencies that, when present together, create a therapeutic conundrum. We present an illustrative case of a 65-year-old man with unprovoked submassive PE and moderate hemoptysis due to pulmonary infarction. Hemoptysis precluded systemic anticoagulation. Failing a conservative management strategy, we administered nebulized tranexamic acid. After four doses of nebulized tranexamic acid 500 mg, 6 hours apart, hemoptysis had ceased. Systemic anticoagulation with intravenous heparin was then successfully commenced 12 hours after the last episode of hemoptysis. The patient was weaned off high-flow nasal oxygen therapy over the course of the next 5 days with no hemoptysis recurrence. Noting the absence of trial evidence, but good pharmacological rationale and our positive experience, we suggest tranexamic acid is a useful noninvasive treatment option for the management of such conditions. Consent for this publication was obtained from the patient.

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Section: Discussionmentioning

confidence: 99%

Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism

Dhanani

Roberts

Reade

2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…There are nine case reports of patients who suffered acute myocardial infarction hours to days after TXA, though most of these patients did not have previously known coronary artery disease or other vascular comorbidities indicating elevated risk (table 1). 2 8–10 12–16 Seven patients had no known coronary artery or vascular disease, whereas two had a significant cardiac history. In six of these cases, the mechanism of acute myocardial infarction (MI) was thrombosis or acute plaque rupture requiring coronary intervention (stent placement in five of six, and only balloon angioplasty in one case), and of these five out of six had STEMIs with one non-ST-elevation MI (NSTEMI).…”

Section: Discussionmentioning

confidence: 99%

“…These articles report TXA use in a variety of surgical settings, including trauma surgery in which TXA significantly reduced all-cause mortality and death due to bleeding,7 orthopaedic surgery in particular total hip and knee arthroplasty,1 4–6 cardiac surgery including coronary artery bypass grafting (CABG) and combined CABG with valve replacement,3 6 and other surgeries including cranial and orthognathic, gynaecological, hepatic, urological and vascular surgeries 6. These trials included very few patients at high risk for arterial or venous thromboembolic complications, since TXA is considered high risk in these populations 2 4 8 9. This included patients with current or prior arterial or venous thromboembolic disorders such as deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disease or stroke, transient ischaemic attack, vascular or arterial stents and chronic hypercoagulable states 1.…”

Section: Introductionmentioning

confidence: 99%

Acute ST-elevation myocardial infarction due to in-stent thrombosis after administering tranexamic acid in a high cardiac risk patient

Kaptein¹

2019

BMJ Case Rep

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Tranexamic acid (TXA) is an antifibrinolytic which minimises bleeding and transfusions, with thrombotic risk. Our patient had known coronary artery disease with post-TXA acute ST-elevation myocardial infarction (STEMI) due to in-stent thrombosis. He had five drug-eluting stents (DES): two overlapping DES in mid-LAD (3 years ago), and two overlapping DES in distal right coronary artery and one DES in obtuse-marginal (1.5 years ago). After TXA, both overlapping stent locations thrombosed. Of nine reports of post-TXA acute MI, only one had complex stent anatomy (bifurcation stent to left circumflex/first obtuse-marginal) with other single stents, and only the complex stent thrombosed. Post-TXA MI was more often STEMI caused by arterial thrombosis, rather than non-STEMI caused by blood loss, hypotension or demand ischaemia. Overlapping and bifurcation stents thrombosed; single stents remained patent. In conclusion, overlapping stents, bifurcation stents, excessive stent length and previous in-stent restenosis/thrombosis may increase thrombotic risk. TXA should be administered cautiously with complex stent anatomy.

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“…12 TXA is an antifibrinolytic drug for which in vivo data shows an association with thrombus formation, 13 and there are numerous case reports of clinically significant thrombotic events associated with TXA use. [14][15][16] However, the majority of RCTs of TXA in the arthroplasty setting have been small, moderate-quality trials primarily designed to examine bleeding endpoints. None have had sufficient power to demonstrate a difference in clinically important adverse events.…”

Section: Introductionmentioning

confidence: 99%

A survey of anaesthetists’ use of tranexamic acid in noncardiac surgery

Painter

McIlroy

Myles

et al. 2019

Anaesth Intensive Care

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Major bleeding in noncardiac surgery is common and associated with serious complications. The antifibrinolytic agent tranexamic acid (TXA) reduces bleeding and may reduce the risk of these complications. TXA also may have immunomodulatory effects that could reduce surgical site infection. Clinical trials of TXA in noncardiac surgery have been insufficiently powered to evaluate its efficacy and safety. Therefore, large randomised controlled trials of its use in noncardiac surgery are required. To ensure that future clinical trials are feasible and acceptable, we undertook a survey of Fellows of the Australian and New Zealand College of Anaesthetists (ANZCA). Our aims were to ascertain current patterns of TXA administration and to assess the acceptability of randomising patients to intravenous TXA or placebo. A 12-item survey was electronically mailed to 1001 ANZCA Fellows. Two hundred and eighty nine responses were received and analysed (response rate 29%). Ninety-eight percent of respondents had used intravenous TXA in noncardiac surgery; 67% give TXA routinely for lower limb arthroplasty, with smaller proportions giving TXA for spinal surgery (40%) and other major orthopaedic surgery (28%). Almost half (49%) give TXA routinely for major trauma surgery. Thirty-six percent indicated that they did not give TXA for major vascular, abdominal, pelvic or thoracic surgery. The majority administered TXA as a single, fixed dose. Fifty-seven percent agreed that there is uncertainty about the relative risks and benefits of perioperative TXA in noncardiac surgery and 87% agreed that large definitive trials determining the safety and efficacy of perioperative TXA in noncardiac surgery are required. These results indicate that for ANZCA Fellows the use of TXA in noncardiac surgery is highly variable, that there is uncertainty about the safety and efficacy of TXA, and that a large trial would be acceptable.

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Left ventricle thrombus after tranexamic acid for spine surgery in an HIV-positive patient

Cited by 9 publications

References 44 publications

Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism

Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism

Acute ST-elevation myocardial infarction due to in-stent thrombosis after administering tranexamic acid in a high cardiac risk patient

A survey of anaesthetists’ use of tranexamic acid in noncardiac surgery

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